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The goals of this retrospective cohort analysis were to determine real-world dose and titration patterns of sacubitril/valsartan (SAC/VAL), a heart failure medication, and examine whether dose patterns are associated with healthcare utilization and costs. Adult health plan members (18-100 years old) who initiated SAC/VAL between 2020 and 2022 and had continuous enrollment 6 months prior to, and at least 3 months following SAC/VAL initiation were identified. Members also had to have 3 months of SAC/VAL fills with good adherence (N =  2,977). Claims data were used to characterize dosage patterns and compare total costs of care, as well as all-cause and heart failure- hospital admissions across those with different terminal SAC/VAL doses. Most members initiated SAC/VAL at the lowest dose (76%, n =  2,267), of whom few titrated upward by their final fill (31%, n =  703). Overall, only 19% (n =  563) were at target by their final fill. Those ending on higher doses experienced significantly fewer all-cause admissions (incidence rate ratios of 1.52 [SE = .16] to 2.66 [SE = .37]; ps < .001) and incurred significantly lower total costs of care while on SAC/VAL (cost ratios of 1.21 [SE = .06] to 1.48 [SE = .09]; ps < .001). Most individuals initiate and remain on the lowest SAC/VAL dose despite guidelines to titrate upward. SAC/VAL dosage is significantly associated with outcomes, with higher doses associated with more clinical and cost benefits. Research is needed to identify barriers to dose titration and to develop interventions for maximal patient benefit.

Severe viral respiratory diseases, such as SARS-CoV-2, are transmitted through aerosol particles produced by coughing, talking, and breathing. Medical procedures including tracheal intubation, extubation, dental work, and any procedure involving close contact with a patient’s airways can increase exposure to infectious aerosol particles. This presents a significant risk for viral exposure of nearby healthcare workers during and following patient care. Previous studies have examined the effectiveness of plastic enclosures for trapping aerosol particles and protecting health-care workers. However, many of these enclosures are expensive or are burdensome for healthcare workers to work with. In this study, a low-cost plastic enclosure was designed to reduce aerosol spread and viral transmission during medical procedures, while also alleviating issues found in the design and use of other medical enclosures to contain aerosols. This enclosure is fabricated from clear polycarbonate for maximum visibility. A large single-side cutout provides health care providers with ease of access to the patient with a separate cutout for equipment access. A survey of medical providers in a local hospital network demonstrated their approval of the enclosure’s ease of use and design. The enclosure with appropriate plastic covers reduced total escaped particle number concentrations (diameter > 0.01 μm) by over 93% at 8 cm away from all openings. Concentration decay experiments indicated that the enclosure without active suction should be left on the patient for 15–20 minutes following a tracheal manipulation to allow sufficient time for >90% of aerosol particles to settle upon interior surfaces. This decreases to 5 minutes when 30 LPM suction is applied. This enclosure is an inexpensive, easily implemented additional layer of protection that can be used to help contain infectious or otherwise potentially hazardous aerosol particles while providing access into the enclosure.

Although older adults are more frequently adopting smartphone technologies, factors influencing decisions for uptake and continued use remain complex. This study explored how perceptions and use of a smartphone app changed from pre-adoption through initial use. Participants were interviewed before, during, and after being introduced to a COPD app to assess their experiences with and perceptions of the app over a 4-month period. Prior to app introduction, participants reported technology, health behavior, and contextual barriers to engaging with health technology. After app introduction, many technology-based barriers lessened over time as participants became more familiar with the app. Other barriers, such as perceived lack of relevance and competing health and life concerns, remained as challenges to use. Results point to the need for apps that can cater to the diverse needs and other life challenges of older adults. Opportunities for assistance from technical support lines, family, friends, and/or community are required.

The goals of this retrospective cohort analysis were to determine real-world dose and titration patterns of sacubitril/valsartan (SAC/VAL), a heart failure medication, and examine whether dose patterns are associated with healthcare utilization and costs. Adult health plan members (18-100 years old) who initiated SAC/VAL between 2020 and 2022 and had continuous enrollment 6 months prior to, and at least 3 months following SAC/VAL initiation were identified. Members also had to have 3 months of SAC/VAL fills with good adherence (N = 2,977). Claims data were used to characterize dosage patterns and compare total costs of care, as well as all-cause and heart failure- hospital admissions across those with different terminal SAC/VAL doses. Most members initiated SAC/VAL at the lowest dose (76%, n = 2,267), of whom few titrated upward by their final fill (31%, n = 703). Overall, only 19% (n = 563) were at target by their final fill. Those ending on higher doses experienced significantly fewer all-cause admissions (incidence rate ratios of 1.52 [SE = .16] to 2.66 [SE = .37]; ps < .001) and incurred significantly lower total costs of care while on SAC/VAL (cost ratios of 1.21 [SE = .06] to 1.48 [SE = .09]; ps < .001). Most individuals initiate and remain on the lowest SAC/VAL dose despite guidelines to titrate upward. SAC/VAL dosage is significantly associated with outcomes, with higher doses associated with more clinical and cost benefits. Research is needed to identify barriers to dose titration and to develop interventions for maximal patient benefit.

The goals of this retrospective cohort analysis were to determine real-world dose and titration patterns of sacubitril/valsartan (SAC/VAL), a heart failure medication, and examine whether dose patterns are associated with healthcare utilization and costs. Adult health plan members (18-100 years old) who initiated SAC/VAL between 2020 and 2022 and had continuous enrollment 6 months prior to, and at least 3 months following SAC/VAL initiation were identified. Members also had to have 3 months of SAC/VAL fills with good adherence (N = 2,977). Claims data were used to characterize dosage patterns and compare total costs of care, as well as all-cause and heart failure- hospital admissions across those with different terminal SAC/VAL doses. Most members initiated SAC/VAL at the lowest dose (76%, n = 2,267), of whom few titrated upward by their final fill (31%, n = 703). Overall, only 19% (n = 563) were at target by their final fill. Those ending on higher doses experienced significantly fewer all-cause admissions (incidence rate ratios of 1.52 [SE = .16] to 2.66 [SE = .37]; ps < .001) and incurred significantly lower total costs of care while on SAC/VAL (cost ratios of 1.21 [SE = .06] to 1.48 [SE = .09]; ps < .001). Most individuals initiate and remain on the lowest SAC/VAL dose despite guidelines to titrate upward. SAC/VAL dosage is significantly associated with outcomes, with higher doses associated with more clinical and cost benefits. Research is needed to identify barriers to dose titration and to develop interventions for maximal patient benefit.

The decontamination of large areas that have been exposed to chemical weapons is a critical component of defence and anti-terrorist strategies around the world 1 , 2 , 3 . Until now, nerve agents could be decontaminated only with bleach treatment and/or ex situ incineration 4 , which had severe environmental consequences. Small-scale methods of decontamination and demilitarization are available, but the problem of decontamination over a wide area has not been solved 2 , 3 . Here we incorporate organophosphorus hydrolase (OPH), an enzyme that hydrolyses nerve agents, into aqueous fire-fighting foams to catalyse surface decontamination. The performance of enzyme-containing foams is reproducible and predictable in detoxifying organophosphorus nerve toxins deposited onto surfaces. Such foams are an environmentally friendly alternative to current decontamination solutions, which are nonspecific in their action and contain significant amounts of hazardous organic solvents.

Many health care systems are investing resources in identifying social determinants of health (SDoH) needs and facilitating interventions among the populations they serve. Because self-reported SDoH information is lacking, area-level measures are often used to estimate needs and direct resources. To describe the large-scale deployment of SDoH assessments by a health system and determine the extent to which self-reported SDoH needs identified therein are associated with census tract-level social vulnerability measured using the Social Vulnerability Index (SVI). This cross-sectional study assessed SDoH needs between January 1, 2020, and April 30, 2023, in both payer and clinical care settings. Modalities included telephonic outreach, face-to-face clinical interactions, self-entry into a tablet or kiosk, and web-based survey tools. Participants included individuals who responded to the assessment and had sufficient information for census tract identification. Respondents included both Highmark Health Plan members and nonmembers. Health plan members responded to the assessment through health plan programs or platforms, and both members and nonmembers responded to assessments during inpatient or outpatient encounters with the affiliated health system. Overall and domain-specific SDoH needs self-reported through assessments, and severity and complexity of needs identified. Residential social vulnerability measures included overall SVI and the 4 conceptual themes comprising overall SVI. In total, 841 874 assessments were recorded for 401 697 individuals (55.1% women; median [IQR] age, 55 [41-70] years). Social determinants of health needs were identified in 120 769 assessments (14.3%). Across all SDoH domains, increasing SVI was associated with a higher positivity rate (eg, 11.2% of those residing in the lowest-risk SVI quintile reported a need compared with 22.7% among those residing in the highest-risk quintile). Associations varied by SDoH domain and SVI theme. After adjusting for demographic and screening characteristics, odds of positive screening among those residing in the highest-risk SVI quintile were 1.74 (95% CI, 1.62-1.86) to 3.73 (95% CI, 3.48-4.00) times the odds among those residing in lowest risk quintile. In this cross-sectional study, the overall level of SDoH needs generally corresponded to area-level vulnerability. Some SDoH domains appeared far more sensitive to community characteristics than others. Notably, even among individuals from the highest-risk areas, the positive screening rate was roughly 1 in 4. These findings underscore the importance of individual-level SDoH data for service provision planning and health services research.